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OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 1423 Salem Street
North Andover,MA 01845
Owner's Name: Arnab&Kimberly Chakravarti
Date of Inspection: 10-29-2007
TIGHT or HOLDING TANK:_(tank must be pumped at time of inspection)(locate on site plan)N/A
Depth below grade:
Material of construction: concrete metal fiberglass_polyethylene other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
DISTRIBUTION BOX: X (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: 0"
Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of
leakage into or out of box,etc.): Flow checked oka
PUMP CHAMBER: X (locate on site plan)
Pumps in working order(yes or no):—Yes`
Alarms in workingorder es or no
(Y :)
_ esY�
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc)
Components worked properly. Secondary floats are in working order.